Human ovarian tissue xenotransplantation: advancements, challenges, and future perspectives

Ovarian tissue cryopreservation and transplantation has emerged as a promising fertility preservation technique for individuals facing premature ovarian insufficiency due to various medical conditions or treatments. Xenotransplantation, involving the transplantation of ovarian tissue into animal hosts, has played a pivotal role in refining ovarian tissue cryopreservation and transplantation techniques and addressing key challenges. This review provides a comprehensive overview of the current landscape of ovarian tissue xenotransplantation research, focusing on its applications in investigating ovarian biology, optimizing ovarian tissue cryopreservation and transplantation protocols, and assessing safety concerns. It also explores the utilization of xenografting of human ovarian tissue in mouse models in the last 10 years. Key findings from preclinical studies investigating grafting site optimization, cryopreservation protocol refinement, the development of strategies to mitigate chemotherapy-induced damage, follicle development, tissue revascularization, and the risk of malignant cell reintroduction are summarized. Moreover, the review examines the ethical considerations surrounding the use of animals in ovarian tissue xenotransplantation research and suggests emerging alternative models that aim to minimize animal use while maximizing clinical relevance.